Laparoscopic Right Hepatectomy Via an Anterior Approach for Hepatocellular Carcinoma

BACKGROUND AND OBJECTIVES: In the past, right hepatectomy via the anterior approach has been regarded as one of the many standard approaches for hepatectomy. However, total laparoscopic right hepatectomy from the anterior approach has been regarded as technically challenging. We report our experience in using the anterior approach in total laparoscopic right hepatectomy for hepatocellular carcinoma (HCC). METHODS: From June 2013 through December 2015, five consecutive patients underwent total laparoscopic right hepatectomy using the anterior approach, but without the hanging maneuver. RESULTS: The mean operative time was 360 (range, 300–480) minutes, and the mean blood loss was 340 (110–600) mL. No patient needed any blood transfusion. There was no conversion to open surgery. Ascites, pleural effusion, and bile leakage occurred in 2, 1, and 1 patients, respectively. No patients expired as a result of the surgery or liver failure. The mean hospital stay was 7 (4–15) days. All patients had R0 resection. After a mean follow-up of 22 (8–33) months, no patients experienced recurrence of disease. CONCLUSION: Total laparoscopic right hepatectomy using the anterior approach is feasible and safe.